Recent Legislation and Public Policy

ARxC Supported Legislation for January 9, 2017  - March 2017 Session.

Georgia Legislative Update: Sine Die - updated April 3, 2017

After the confetti flew, the House and Senate Chambers became quiet and the legislative session ended Friday, March 31, it was clear, bold legislative initiatives were lacking this year. There was disappointment over crucial pieces of legislation that did not pass.

SB 8: Surprise billing legislation | DID NOT PASS
Legislators failed to reach an agreement about how to best resolve the problem of surprise out of network billing for Georgia consumers. However, legislators committed to continuing their work on this issue by passing HR 745 which creates a study committee that will examine "surprise insurance gaps" and balance billing.

HB 188: Expand Medicaid NOW Act | DID NOT PASS
Sponsored by House Minority Leader Stacey Abrams, this bill was not expected to gain much traction because of the uncertain environment created by federal health care reform efforts. However, it calls attention to the need to provide health care coverage to the 300,000 Georgians who are stuck in our state's coverage gap because they do not currently qualify for Medicaid and cannot access health insurance through the Affordable Care Act's Marketplace. 

HR 182 & SR 349: Resolutions supporting Medicaid block grants | DID NOT PASS 
Both of these resolutions encouraged the restructuring of Georgia's Medicaid program from its current federal-state partnership structure to a block grant program. SR 349 urged the U.S. Congress to block grant funding for Georgia's Medicaid program and indigent care needs, while HR 182 provided legislative permission to the Governor and the Department of Community Health to seek per capita block grant funding for Medicaid.  Shifting Medicaid to either a traditional or per capita block grant structure would result in cuts to services and beneficiaries, putting Georgia's most vulnerable children, parents, elderly, and people with disabilities at risk.

SB 4: Mental Health Treatment Task Force | DID NOT PASS

SB 4 establishes a task force that is charged with examining the current mental health landscape in Georgia, how Medicaid and other health care services provide the appropriate care for people with mental illness or substance use disorders, and determine what changes may need to be made in and outside of Medicaid to better address the mental health needs of Georgians.

What we did accomplish:

HB 276/SB 103: Pharmacy Patients Fair Practices Act | PASSED
HB 276 and SB 103 both regulate pharmacy benefit managers, which are third party companies that manage the prescription drug programs of many insurance plans. Both bills would prohibit PBMs from certain practices that limit consumer access and choice to preferred pharmacies and to lower cost drugs. Both bills passed their respective chambers. *This bill is important for patients and their physicians in deciding the best choice of treatment and to start to curb the high cost of prescription drugs.

HB 154: Oral health legislation | PASSED
This legislation allows for the "general supervision" of dental hygienists, which means hygienists can practice in safety net settings, school clinics, nursing homes, and private practices without a dentist being present. 

SB 16: Medical marijuana access | PASSED
This legislation expands the list of conditions for which Georgians who have registered with the Department of Public Health may possess low THC oil. The newly added diagnoses include Alzheimer’s disease, AIDS, autism, epidermolysis bullosa, peripheral neuropathy and Tourette’s syndrome. Patients in hospice care may also possess the oil.

HB 249: Opioid crisis bill | PASSED
HB 249 moves the Prescription Drug Monitoring Program (PDMP) to the Department of Public Health from the Georgia Drugs and Narcotics Agency. HB 249 requires that all physicians register and consult the PDMP under certain prescribing conditions and that providers report certain benzodiazepine and opioid-based prescriptions to the database. The bill also requires the tracking and reporting of Neonatal Abstinence Syndrome and codifies the Governor’s emergency order on an overdose reversal drug (naloxone), making it available without a physician prescription.

SB 121: Access to opioid antagonists | PASSED
SB 121 codifies Governor Deal's executive order to allow consumers to access opioid antagonist drugs (e.g. Naloxone) over-the-counter without a prescription.

SB 180: Expansion of rural hospital tax credits | PASSED
After HB 54 failed to pass the House before Crossover Day, its language was amended to SB 180. The legislation expands the new rural hospital tax credit program from a 70% credit to a 90% credit, among other minor changes.

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Rx in Reach GA Coalition: HB 519: Step Therapy Bill| DID NOT CROSS OVER Requires health benefit plans to utilize certain clinical review criteria to establish step therapy protocols; to provide for a step therapy override determination process; to provide for definitions; to provide for statutory construction; to provide for rules and regulations; to provide for applicability; to provide for related matters; to repeal conflicting laws; and for other purposes. We will continue to push for this vital legislation. http://www.legis.ga.gov/legislation/en-us/display/20172018/hb/519

State budget includes important health items

The FY 2018 budget passed the House in mid-February and is now being considered by the Senate. As passed by the House, the budget includes increased Medicaid reimbursement rates for certain primary care codes and pediatric dental codes, which help to increase access to care for people with Medicaid coverage. The budget also includes funding for two new federally qualified health centers in Cook and Liberty counties. Additionally, the budget includes enhanced funding for supportive housing, an important determinant of health for people with behavioral health issues. 

ALERT : Senate "Repeal and Replace" Task Force
Early in the legislative session, the Senate established a task force to address impacts to Georgia from any federal changes to the Affordable Care Act. This committee has convened twice, but has not yet scheduled a public meeting. It is unlikely to be a very active committee until there is clarity at the federal level about the direction of health care policy changes, and which provisions or concepts of the ACA will be kept or repealed. 

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ARxC Supported Legislation for January 11, 2016   - March 24, 2016 Session.

SB 302: Insurance; require health carriers to maintain accurate provider directories: A BILL to be entitled an Act to amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to require health carriers to maintain accurate provider directories; to provide for definitions; to provide for electronic and printed provider directories; to require certain information in provider directories; to grant enforcement authority to the Commissioner; to provide for related matters; to repeal conflicting laws; and for other purposes.  PASSED

HB 965: “The Honorable Jimmy Carter Cancer Treatment Access Act”: A BILL to be entitled an Act to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to general insurance provisions, so as to provide that no health benefit plan shall require an insured to fail to successfully respond to a drug or drugs for stage four advanced, metastatic cancer prior to the approval of a drug prescribed by his or her physician; to provide for definitions; to provide for a short title; to provide for legislative findings and intent; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED

SR 974: Senate Surprise Billing Practices Study Committee; create A RESOLUTION creating the Senate Surprise Billing Practices Study Committee; and for other purposes. Senate Favorably Reported

SR 1043: Expansion on Autism Insurance Mandate; create Senate Study Committee: A RESOLUTION creating the Senate Study Committee on the Expansion of Autism Insurance Mandate to ERISA Plans; and for other purposes. Senate Favorably Reported

HB 768: Handicapped persons; ABLE program establishment to use tax exempt accounts to pay for qualified expenses of eligible individuals with disabilities; provisions: A BILL to be entitled an Act to amend Title 30 of the O.C.G.A., relating to disabled persons, so as to provide for the establishment of a qualified ABLE program in this state to enable the contribution of funds to tax-exempt accounts to pay for the qualified expenses of eligible individuals with disabilities; to amend Code Section 48-7-27 of the O.C.G.A., relating to computation of taxable net income; to amend Code Section 50-13-2 of the O.C.G.A., relating to the definitions for purposes of the Georgia Administrative Procedure Act, so as to exclude the Georgia ABLE Program Corporation from the meaning of “agency”; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes. PASSED by Substitute and Amended

HB 897: Health; care and protection of indigent and elderly patients; provide for the establishment and operation of a drug repository program to accept and dispense unused prescription drugs. A BILL to be entitled an Act to amend Chapter 8 of Title 31 of the O.C.G.A., relating to the care and protection of indigent and elderly patients, so as to provide for the establishment and operation of a drug repository program to accept and dispense unused prescription drugs; to amend Chapter 4 of Title 26 of the O.C.G.A., relating to pharmacists and pharmacies, so as to repeal the “Utilization of Unused Prescription Drugs Act”; to amend Article 7 of Chapter 4 of Title 49 of the O.C.G.A., relating to medical assistance generally, so as to revise a provision for purposes of conformity; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED by Substitute

SB 158: “Insurer Transparency Act”; provide certain consumer and provider protections regarding health insurance.  A BILL to be entitled an Act to amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to provide certain consumer and provider protections regarding health insurance; to provide for definitions; to provide for short titles; to provide for health insurer transparency; to provide for health care providers’ right to choose; to provide for health care provider stability; to provide for consumer right to access; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED by Substitute

HB 919: Health; rural health care organizations which provide health care services to underserved areas; approve.  A BILL to be entitled an Act to amend Titles 31 and 48 of the Official Code of Georgia Annotated, relating to health and revenue and taxation, respectively, so as to approve rural health care organizations which provide health care services to underserved areas in this state; to provide for definitions; to provide for tax credits for contributions to rural health care organizations; to provide for the amount, nature, limits, and procedures for such tax credits; to provide for related matters; to provide for applicability; to repeal conflicting laws; and for other purposes. House passed by Substitute

SB 368: Medical Assistance; eligible individuals to obtain health care coverage; provide program of premium assistance. A BILL to be entitled an Act to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, so as to provide for a program of premium assistance to enable eligible individuals to obtain health care coverage; to provide for definitions; to require personal responsibility premiums from eligible individuals; to provide for a compliance pool; to provide for any necessary state plan amendments or federal waivers; to provide for termination of the program under certain circumstances; to provide for the Legislative Oversight Committee for Health Care Premium Assistance; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

SB 382: “Surprise Billing and Consumer Protection Act”; provide for consumer protections regarding health insurance.  A BILL to be entitled an Act to amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to provide for consumer protections regarding health insurance; to provide for definitions; to provide for disclosure requirements of providers, hospitals, and insurers; to provide for billing and reimbursement of out-of-network services; to provide for procedures for dispute resolution for surprise bills for nonemergency services; to provide for payment of emergency services; to provide for an out-of-network reimbursement rate workgroup; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

HB 875: “Patient Access to Specialty Tier Drugs Act”; enact A BILL to be entitled an Act to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require issuers of health benefit policies to provide certain information to enrollees and establish certain processes and limits relating to specialty drugs; to provide for a short title; to define terms; to provide specific requirements for issuers; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

SB 245: Insurance; provide for access to opioid analgesics with abuse-deterrent properties; definitions. A BILL to be entitled an Act to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to general provisions of insurance, so as to provide for access to opioid analgesics with abuse-deterrent properties; to provide for definitions; to provide for coverage as a preferred drug; to provide for utilization management; to provide for legislative findings; to provide for related matters; to provide for applicability; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

SB 299: Georgia Health Care Transparency Initiative; create; definitions; purpose. A BILL to be entitled an Act to amend Chapter 1 of Title 33 of the Official Code of Georgia Annotated, relating to general provisions of insurance, so as to create the Georgia Health Care Transparency Initiative; to provide for definitions; to provide for a purpose; to provide for a Georgia Health Care Initiative Board; to provide for the board’s membership and duties; to provide for the Commissioner’s duties; to provide for subcommittees; to provide for submission of data and its uses; to provide for data confidentiality; to provide for penalties; to provide for funding; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

HB 834: Health; establish charity care organizations for healthcare for the uninsured; provide tax credit. A BILL to be entitled an Act to amend Title 31 and Title 48 of the Official Code of Georgia Annotated, relating to health and revenue and taxation, respectively, so as to establish charity care organizations to provide health care services to the uninsured in this state; to provide for definitions; to provide for tax credits for contributions to charity care organizations; to provide for the amount, nature, limits, and procedures for such tax credits; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

HB 823: “Expand Medicaid Now Act”; enact.  A BILL to be entitled an Act to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, so as to provide for the authorization of appropriations for the purposes of obtaining federal financial participation for medical assistance payments to providers of Medicaid expansion under the federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010; to provide for a maximum percent of the federal poverty level; to provide for a short title; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

SB 38: Medicaid; authorization of appropriations; medical assistance payments to providers of Medicaid expansion.  A BILL to be entitled an Act to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, so as to provide for the authorization of appropriations for the purposes of obtaining federal financial participation for medical assistance payments to providers of Medicaid expansion under the federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010; to provide for certain restrictions; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.

SB 364: A BILL to be entitled an Act to amend Article 6 of Chapter 2 of Title 20 of the Official Code of Georgia Annotated, relating to the "Quality Basic Education Act," so as to revise provisions relating to annual teacher, principal, and assistant principal evaluations; to revise provisions relating to student assessment; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED by Substitute

HR 1382: A RESOLUTION encouraging the Department of Community Health to create and seek the counsel of a State Health Benefit Plan Customer Advisory Council; and for other purposes. PASSED

HB 853: Bill will update the policy to reflect advances in stroke treatment and therapy. Specifically, it will add a third designation - Comprehensive Stroke Centers - to assure that stroke patients may be quickly identified and transported to facilities that have specialized programs for providing timely and effective treatment for stroke patients. PASSED House by Substitute; onto the Senate.

 

Analysis and Report to Inform Efforts to Promote Access to Affordable Prescription Drugs

In August 2016, consumer representatives to the National Association of Insurance Commissioners (NAIC) issued the Promoting Access to Affordable Prescription Drugs: Policy Analysis and Consumer Recommendations for State Policymakers, Consumer Advocates, and Health Care Stakeholders report. This report includes a series of recommendations to assist regulators, lawmakers, and the NAIC on ways to promote access, affordability, nondiscrimination, transparency, and meaningful oversight of prescription drug coverage. This report addresses state regulatory commissions power to monitor plans and adjust formulary design to reduce discrimination based on medical conditions. It also addresses Pharmacy Benefits Mangers role and oversight along with more transparency of drug formularies. ARxC and our fellow consumer representatives will continue to monitor the recommendations in this report for their discussion and implementation by the insurance industry. We thank our friends at Georgians for a Healthy Future for their vital contribution to this publication.

 

Specialty Tier Legislation

Insurance plans have traditionally included a three-tiered structure for prescription drugs - each with its own patient co-pay limits. Insurance companies are increasingly moving medications to "specialty -tiers" where there are no limits on what the patient is required to pay for their specialized medications.

ARxC and the Specialty Tier Coalition of Georgia put forward HB 875 or the Patient “Patient Access to Specialty Tier Drugs Act.” This bill was designed to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require issuers of health benefit policies to provide certain information to enrollees and establish certain processes and limits relating to specialty drugs; to provide for a short title; to define terms; to provide specific requirements for issuers; to provide for related matters; to repeal conflicting laws; and for other purposes. Unfortunately this bill was not brought to hearring and did not cross over.

Go to www.rxinreachga.org/legislation/ to learn more about this bill and how you can get involved in securing access to vital drugs.

 

Support Part D Beneficiary Appeals Fairness Act 

Part D Beneficiary Appeals Fairness Act - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act, with respect to a prescription drug plan (PDP) that provides for any tiered cost-sharing within a formulary (including a structure that provides for different co-payment or coinsurance amounts for drugs in different tiers included within the formulary), to authorize a Medicare part D eligible individual enrolled in the plan to request an exception to the tiered cost-sharing structure.
 
States that in no case may the Secretary of Health and Human Services (HHS) allow a PDP sponsor to make any element of the tiered cost-sharing structure (including a tier used for very high cost or unique items) ineligible for lower-cost sharing through an exception.
 
ARxC applauds Representative Hank Johnson's leadership in sponsoring this bill.
 
STATUS: Click here
 
 
Oppose Fail First Policies
 
When a patient has to Fail First on a drug before being allowed to take the medication originally prescribed, the patient, physician and public health suffers. ARxC has partnered with the Global Healthy Living Foundation and other groups to oppose Fail First policies in Georgia and throughout the country. These dangerous policies are commonly used by health insurance companies to reduce their costs and improve their profit margins. These policies unnecessarily intrude on the patient/physician relationship, prolong illness, and can allow permanent damage to occur, ultimately costing more money, increasing lost productivity, and reducing patient quality of life.
 
STATUS: Click here to learn what other states are doing with regard to legislation that restricts or prohibits the use of Fail First policies.
 
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Past Federal or State Legislation and Regulations Supported or Opposed by ARxC
 
February 8, 2015
HB 195 will maintain transparency while establishing a state based policy for affordable access to biosimilars that ensures the wellness of all Georgians. 
 
The core principles that we believe should guide substitution policies for biosimilars under Georgia state law include:

​   a) Substitution should occur only when the FDA has designated a biologic product as interchangeable.

   b) The prescribing physician should be able to prevent substitution.

   c) The prescribing physician should be notified of any actions toward substitution within 48 hours.

   d) The patient, or the patient’s authorized representative, should, at a minimum, be notified of any substitution within 48 hours.

   e) The pharmacist and the physician should keep records of any substitution.

   f)  Biosimilars should stay in the traditional three tiers of the drug formulary which will ensure co-pays and co-insurance payments remain affordable to encourage compliance with treatment, preventing any compromise of the patients’ health and quality of life.

 
March 14, 2014
House Bill 707 would prohibit the state of Georgia from leveraging federal dollars to cover the uninsured and from providing consumer assistance to Georgians enrolling in health insurance.
 
HB 707 was designed and promoted to prevent hard-working Georgians from accessing health care, and it is in danger of becoming law in Georgia. We need your voice! Georgia citizens deserve better than to have the door slammed in their face when they seek out information about how to cover themselves and their family. Our state’s struggling hospitals and uninsured citizens deserve an honest policy discussion about Medicaid expansion, not a gag order on state and local employees.
 
Other details about HB 707 can be found on the Georgians for a Healthy Future Action Alert.
 
March 7, 2014
ARxC is invested in assuring that payers cover and maintain coverage for vital services. In March 2014, ARxC expressed our strong opposition to the sudden and drastic changes to Medicare Part D that were proposed by the Centers for Medicare and Medicaid Services (CMS) in our letter to CMS Administrator Tavenner. ARxC then joined 200 organizations and groups demanding that the rule be withdrawn in a shared letter to CMS that was widely publicized.  CMS responded by issuing a letter to Congress that states "...Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time..."
 
February 19, 2014
Georgia HB 990 would require any sitting Georgia Governor to get legislative approval before expanding Medicaid. This bill is just another roadblock to Medicaid expansion and will cause bureaucratic delays in extending Medicaid to over 500,000 medically under-served Georgians.
 
To find out more about HB 990 and how you can get involved in efforts to expand Medicaid to low income Georgians read this Cover Georgia Action Alert.
 
Supported Georgia HB 644
March 2013
HB 644 required health insurance issuers "to make certain disclosures to enrollees; to provide for definitions; to require notice to an enrollee of a modification affecting drug coverage; to provide that certain copayment or cost-sharing amounts continue to apply for a certain duration; to provide for
related matters..."
 
This bill was not passed and has since been changed and modified into the new Prescription Transparency Act (see above).
 
Support Repealing the Independent Payment Advisory Board (IPAB)
August 2011
The Independent Payment Advisory Board (IPAB) was established by the Patient Protection and Affordable Care Act to extend Medicare solvency and reduce spending growth through a spending target system and fast track legislative approval process.  Essentially the IPAB will be making decisions about payment policy in Medicare that will determine whether millions of seniors have access to the care they need. The panel could therefore potentially reduce payments to providers and access to innovative therapies, thus limiting patient access. Seniors are already finding it difficult to find doctors that will take Medicare patients due to previous cuts made to physician’s payments. This situation will be exacerbated with any proposed cuts. 
 
Review ARxC's letters to Congressman Scott and Congressman Johnson to learn more about ARxC's stance on this issue:

- Letter to Congressman Scott

- Letter to Congressman Johnson

Find out more about this issue on the AMA webpage.

Opposed Georgia HB 87
May 2011
H.B. 87 authorizes police to arbirtrarily demand documentation of citizenship or immigration status. It also criminalizes Georgians who interact with undocumented individuals and makes it difficult for immigrants to access state facilities and services.
 
Supported passage of the DREAM Act
May 2011

The DREAM Act seeks to give immigrant students with good moral character who have lived in the U.S. for at least five years -- and came here before turning sixteen -- the chance to earn legal status after earning a high school degree and completing two years of college or military service in good standing.

On May 11, 2011 the DREAM Act was reintroduced to the Senate, but was not passed into law. Many states however, have passed state laws that are similar to the DREAM Act.

On June 15, 2012 President Obama used his executive power to introduce the Deferred Action for Childhood Arrivals (DACA) program to stop the deportation of young undocumented individuals who match certain criteria previously proposed under the DREAM Act. ARxC supports the full implementation of this program. 

Click here to learn more about the bill and how you can get involved in promoting the DREAM Act.